Evaluation of a training programme on knowledge and compliance of nurse assistants' hand hygiene in nursing homes

The aims of this study were to examine the impact of a comprehensive training programme in hand hygiene for nurse assistants (NAs) on their knowledge and compliance, as well as on the infection rate of nursing home residents. An intervention was conducted in northern Taiwan at three long-term care facilities. Forty NAs participated in a hand-hygiene training programme that included 1h of in-service classes and 30 min of hands-on training. Demographic data and NAs' knowledge and compliance regarding hand hygiene were collected and the infection rate of residents calculated. Three months after hand-hygiene training the NAs had significantly more knowledge (from 13.82 to 15.41, P<0.001) and better compliance (from 9.34% to 30.36%, P<0.001) than before the intervention. There was a reduction in residents' infection rate from 1.74% (December 2004 to February 2005) and 2.04% (June 2005 to August 2005) to 1.52% (December 2005 to February 2006) (P<0.001).     

Effectiveness of a training programme to improve hand hygiene compliance in primary healthcare

Background  

Hand hygiene is the most effective measure for preventing infections related to healthcare, and its impact on the reduction of these infections is estimated at 50%. Non-compliance has been highlighted in several studies in hospitals, although none have been carried out in primary healthcare.     

某康复医院手卫生管理效果评价

目的了解采取手卫生管理策略对提高医护人员手卫生依从性的效果。方法对某院临床科室手卫生设施配备情况和医护人员手卫生执行情况进行督查,比较2012年4月和2013年4月（干预前后）医护人员手卫生的依从性。结果2013年4月,抗菌洗手液和干手物品配备合格率分别为88.89%、66.67%,明显高于2012年4月的18.18%和0;医护人员洗手方法合格率（96.43%）和手卫生依从率（81.15%）亦显著高于2012年4月（分别为63.64%、51.40%）,差异有统计学意义（均P＜0.05）;医护人员接触患者前后和接触患者物品后手卫生依从性均显著高于2012年4月（均P＜0.05）。结论采取有效的手卫生管理策略,可提高医护人员手卫生依从性,保障医疗安全。     

Evaluation of a program for updating recommendations about hand hygiene

BACKGROUND. Hand Hygiene (HH) is the most important measure in the prevention of nosocomial infections. The objective was to evaluate the program for updating recommendations on HH that had been introduced. METHODS. Interventions: between March-October/2005 realisation of updating sessions about when and how to realize HH and May/2006 distribution of an explicative three-part document to all healthcare workers reporting on compliance with the recommendations. Indicators: level of knowledge (LK) measured with a questionnaire of five questions that was given to those attending before and after sessions, responses were considered inadequate when three or more questions were not answered; consumption of alcoholic solutions (CAS) on ml/stay grouped into semesters from 2004-2006; compliance (CO) with recommendations on HH was measured by direct observation at two times (December/2005-February/2006 and October-November/2006); and infections prevalence (IP) and patients with infection (IPP) for EPINE studies 2004-2005-2006. RESULTS. The frequency of inadequate answers for evaluating LK has fallen from 57.5% before to 18.9% afterwards (p <0.001). The CAS for HH has passed from 3 ml/stay in 2nd semester/2004 to 17 ml/stay 2nd semester/2006 (p <0.001). The CO with HH has risen from 31.0% to 55.6% (p <0.001). The IP and IPP have risen respectively from 11.4% and 9.6% in 2004 to 9.4% and 8.9% in 2006 (N.S.). CONCLUSION. The program is progressively achieving its objectives as the three process indicators (LK, CAS, CO) have improved in a statistically significant way, and the indicators of results (IP and IPP) have improved but without achieving statistical significance.     

不同手卫生方式及干手措施对手卫生效果的影响

 

目的 调查不同手卫生方式和干手措施对手卫生效果的影响,提高手卫生质量。方法 选择河南省8所哨点医院不同科室的医务人员为调查对象。观察医护人员手卫生方式及干手措施,比较不同手卫生方式及干手措施的手卫生微生物检测合格率。结果 共调查医护人员699人次,执行手卫生者572人次,手卫生依从率为81.83%。洗手是最常用的手卫生措施,占39.34%。监测结果显示,采用速干手消毒剂进行卫生手消毒的合格率最高,为97.92%,不同手卫生方式的手卫生合格率比较,差异有统计学意义（χ²=20.203,P<0.001）。干手措施以自然风干为主（79.37%）,一次性纸巾、自动风干机和其他方式所占比率分别为14.69%、1.75%和4.20%。不同干手措施后的手卫生合格率比较,差异有统计学意义（P=0.013）。洗手组和先洗手后卫生手消毒组别中,均为使用一次性纸巾干手后的合格率最高,分别为80.70%、96.30%。结论 涂抹速干手消毒剂进行卫生手消毒效果可靠,最佳干手措施应首选一次性干手纸巾。

     

手卫生促进活动的实施及效果评价

目的探讨切实可行的手卫生干预方法,以提高医务人员手卫生依从性。方法在武汉地区20所医疗机构开展手卫生促进活动,同时采用问卷调查和现场观察的方法评价干预前后的变化。结果经干预后,医务人员手卫生知识水平明显提高,直接接触患者前的医务人员手卫生执行率从60.59%（143/236）上升至84.08%（243/289）(χ2=36.82,P＜0.001);干预科室的医院感染率从干预前的39.33%（118/300）下降至干预后的31.20%（83/266）（χ2=4.07,P=0.04）,差异均有统计学意义。结论采取积极有效的手卫生促进活动,对提高医务人员手卫生依从性有明显的促进作用,可降低医院感染发生率。     

罗湖区幼儿园儿童手部卫生干预效果评价

评价罗湖区幼儿园手部卫生干预效果,为督促儿童养成良好的手部卫生习惯提供参考.方法 在深圳市罗湖区随机抽取10家幼儿园,共119个班级3 886名儿童.幼儿园内所有儿童均作为干预对象,接受手部卫生综合干预,分别在干预前后观察儿童的手部卫生依从性,并比较干预与对照幼儿园儿童的手足口病发病率,评价干预效果.结果 干预措施有效地提高了儿童手部卫生依从性(RR=2.135,95%CI=1.885~2.417),干预措施对大班儿童(RR=2.559,95%CI=2.134~3.068)以及准备食物前洗手(RR=2.877,95%CI=1.700~4.870)的效果最明显.多因素Logistic回归分析结果发现,除干预措施外(OR=13.903,95%CI=11.276~ 17.141),教师提醒洗手(OR=14.765,95%CI=12.244~ 17.805)是儿童手部卫生依从性最重要的影响因素,但研究未能观察到接受干预幼儿园的儿童手足口病发病率出现明显下降(RR=0.866,95%CI=0.622~1.207).结论 干预措施可有效提高幼儿园儿童手部卫生依从性.     

新生儿呼吸机相关肺炎预防中手卫生作用的探讨

目的探讨手卫生在新生儿呼吸机相关肺炎（VAP）预防中的作用。方法采取回顾性与前瞻性相结合的调查方法,比较2004-2007年间新生儿重症监护室(NICU)改善手卫生设施前后的VAP发生情况。结果在不改变其他条件的情况下,改善洗手及手消毒设施后,VAP发生率显著降低;由之前的30.00%（2004-2005年）降至18.18%（2006-2007年）,且两者差异有高度显著性（χ2=9.44,P＜0.01）。结论手卫生是预防VAP的重要环节,设置完善、方便的洗手和手消毒设施,提高医务人员手卫生依从性,是降低VAP发生率的关键措施之一。     

武汉市小学生手卫生干预效果评价

目的学校是传染病发生与流行的重点场所,建立有力有效的防控措施,可延缓传染病在学校流行的时间、减小流行范围甚至阻止传染病的流行。手卫生属接触预防措施,在预防和控制疾病流行中起到至关重要的作用。本研究通过加强健康教育及手卫生干预措施的实施及其效果评估,促进学校公共洗手设施的改善、规范学生洗手行为,为学校传染病防控策略提供科学依据。方法采取随机对照实验方法,2011-04-01-2012-03-31在湖北省武汉市抽取4个区8所学校,随机分为强化洗手干预组和对照组,在强化洗手干预组安装洗手设施,提供洗手液与擦手纸,干预前后对学生的手卫生行为进行问卷调查和观测,并检验两组学生手卫生学指标。结果共纳入研究对象3 787名,其中强化洗手干预组1 864名,对照组1 923名。强化洗手干预组学生洗手人数比例为50.16%,高于对照组的26.26%,χ~2=326.06,P0.001;强化洗手干预组洗手后擦手学生比例为61.18%,高于对照组的35.25%,χ~2=273.70,P0.001。干预前后强化洗手组学生每天在校内洗手次数分别为(2.95±1.73)和(4.88±2.79)次;差异有统计学意义,t=25.38,P0.001。干预前两组手细菌总数均值分别为9.43和9.76个,干预后两组学生手细菌总数均值分别为4.85和6.54个。干预后两组手细菌卫生学指标监测合格率分别为87.23%和54.76%,差异有统计学意义,χ~2=11.578,P=0.001。干预前后强化洗手干预组学生手细菌卫生学指标监测合格率分别为65.96%(31/47)和87.2%(41/47),差异有统计学意义,χ~2=5.934,P=0.015。结论在小学实施手卫生干预,能有效提高小学生洗手依从性,学校应加强手卫生知识的宣传教育及洗手设施的建设与改善,是学校传染病预防和控制的有效措施。     

医务人员手卫生依从性评价方法的探讨

目的探索手卫生依从性的评价方法。方法采用直接观察法调查2011—2018年某院临床医技科室医务人员手卫生依从率,调取同期全院各科室手卫生用品,包括清洁剂和速干手消毒剂使用量,计算每床日手卫生次数。利用隐蔽式调查的方法结合手卫生用品使用量计算每床日手卫生次数,对直接观察获得的手卫生依从率进行校正,分析霍桑效应。结果采用直接观察法调查2011—2018年手卫生依从率,呈逐年上升趋势(χ2=11 712.41,P0.01),由最初的38.17%提升至94.46%。根据速干手消毒剂和清洁剂每次使用量估算每床日手卫生次数,2011年为12.41次,2018年为22.37次;每床日速干手消毒剂使用量和每床日清洁剂使用量与手卫生依从率均有较好相关性(r值分别为0.82、0.79,均P0.05)。校正后的手卫生依从率为36.87%～69.10%,与直接观察法相差1%～43%。结论采取手卫生用品使用量和手卫生依从率双重指标,对正确评估手卫生具有很好的指导意义,能避免过高评估手卫生依从率。     

Enhancing hand hygiene in a polyclinic in Singapore

Aims This project intended to enhance the compliance rate of nurses (registered nurses and enrolled nurses) in a polyclinic to the five moments of hand hygiene. It proposed to conduct a preliminary baseline audit on the standard of hand hygiene practice, educate nurses on the five moments of hand hygiene in the polyclinic and conduct a post-implementation audit to capture the compliance rate of nurses on practising the five moments of hand hygiene. Methods The team conducted a pre- and post-implementation audit using the Joanna Briggs Institute Practical Application of Clinical Evidence System and Getting Research into Practice programme, from July 2011 through November 2011, over a period of 5?months. The pre-implementation audit, which involved 23 nurses from a polyclinic in Singapore, also adopted five out of the seven criteria suggested by the Joanna Briggs Institute. The intervention composed of educating the nurses on the five moments of hand hygiene, providing guidance to nurses in a non-intimidating manner, adopting an open communication approach and the appropriate placement of alcohol-based hand rub at the point of care in the service rooms. Results The post-implementation audit results showed significant improvement in four of the five criteria, with the greatest improvement observed for criterion 2: 'Hands are decontaminated immediately before each and every episode of direct patient contact or care, and/or all inanimate objects, including equipment'. Conclusion This study has proven that by conducting the pre- and post-implementation audit using the five criteria gathered from the Joanna Briggs Institute Practical Application of Clinical Evidence System, nurses' hand hygiene compliance can be enhanced. From this study, we could also conclude that nurses' knowledge and accessibility/suitability of alcohol-based hand rubs play an important role in achieving better hand hygiene practices. Positive results were seen even though the project was conducted within a short period. Contributing factors could be attributed to efforts by researchers in identifying barriers for compliance from the ground and addressing them in the intervention phase. In addition, the relentless enthusiasm and commitment of stakeholders, team members and nurses had also contributed to the success of this study. This project was the first to report an improvement in the hand hygiene compliance of primary healthcare nurses in Singapore.     

Improving compliance with hand hygiene in hospitals.

Hand hygiene prevents cross-infection in hospitals, but compliance with recommended instructions often is poor among healthcare workers. Although some previous interventions to improve compliance have been successful, none has achieved lasting improvement. This article reviews reported barriers to appropriate hand hygiene and factors associated with poor compliance. Easy access to hand hygiene in a timely fashion and the availability of skin-care lotion both appear to be necessary prerequisites for appropriate hand-hygiene behavior. In particular, in high-demand situations, hand rub with an alcohol-based solution appears to be the only alternative that allows a decent compliance. The hand-hygiene compliance level does not rely on individual factors alone, and the same can be said for its promotion. Because of the complexity of the process of change, it is not surprising that solo interventions often fail, and multimodal, multidisciplinary strategies are necessary. A framework that includes parameters to be considered for hand-hygiene promotion is proposed, based on epidemiologically driven evidence and review of the current knowledge. Strategies for promotion in hospitals should include reasons for noncompliance with recommendations at individual, group, and institutional levels. Potential tools for change should address each of these elements and consider their interactivity.     

手卫生宣传活动对医务人员手卫生的影响

目的评价手卫生宣传活动对医务人员手卫生知晓率、正确率和依从率的效果。方法2014年5月8日开始开展手卫生宣传活动,分别于活动前及活动后第5阶段采用现场提问、理论考核和直接观察方法调查医务人员手卫生知晓率、六步洗手法正确率及依从率,并比较活动前后结果。结果开展手卫生宣传活动后,医务人员手卫生知晓率、六步洗手法正确率及依从率分别由42.50%、35.45%、24.00%提高至87.12%、68.60%、43.20%,差异均有统计学意义（均P＜0.05）。结论通过开展手卫生宣传活动,强化了医务人员手卫生意识,规范了手卫生操作,提高了手卫生依从性。     

The development of the UK radon programme.

The natural radioactive gas, radon, is responsible for the largest component of the radiation dose received by the average UK citizen. The risks of exposure to radon have been demonstrated and quantified in epidemiological studies of those exposed at work and in the home. In the UK, measures are in place to identify and help control the exposures in those houses where levels are highest, to limit levels in new buildings and to control exposures in the workplace. This paper outlines the development of the programme, with special reference to the identification and remediation of homes with high radon levels.